Postnatal management of infants with antenatally detected hydronephrosis

With the increasing use of antenatal sonography, fetal hydronephrosis has been reported more frequently. Because of the lack of consensus regarding treatment of these infants, the postnatal approach toward fetal renal pelvis enlargement remains controversial. The aim of this prospective study is to demonstrate the postnatal investigation, treatment, and outcome of infants with prenatally diagnosed hydronephrosis. Infants whose antenatal ultrasound scan showed a fetal renal pelvis of 5 mm or greater were investigated postnatally using ultrasound (US) and voiding cystourethrography. When indicated, isotope studies and intravenous urograms were also performed. We followed prospectively neonates with antenatally diagnosed hydronephrosis and recommended management guidelines on the basis of our findings. In 156 neonates (193 kidney units) that were found to have hydronephrosis, the average gestational age at which the diagnosis was made was 32.94±5.10 weeks. The mean duration of postnatal follow-up was 26.3±13.56 months (range 3–60 months). The mean APPD of the fetal renal pelvis was 10.35±3.24 mm (5–9 mm in 84 kidneys, 10–14 mm in 96 kidneys and 15 mm in 13 kidneys). Of the 193 kidney units, 145 units were found to be pathological. The most common detected underlying abnormalities were ureteropelvic junction obstruction (in 91 kidneys; 62.7%) and vesicoureteral reflux (in 24 kidneys; 16.6%). Postnatally, 23 (45%) of 51 patients whose first US was normal were diagnosed postnatally as having urinary tract abnormality. There was a negative correlation between APPD and the rate of spontaneous resolution and positive correlation between APPD and the rate of surgery (P<0.01). In conclusion, because it is not possible to determine an upper limit of normal for the antenatal renal pelvis, any baby with AH should not be considered clinically insignificant. Infants with antenatal renal pelvis measurements 5 mm should be investigated postnatally. A normal postnatal ultrasound scan does not preclude the presence of urinary tract abnormality.     

Valve replacement surgery in patients with end-stage renal disease: long-term results

BACKGROUND: The life expectancy of patients with chronic renal failure who are dependent on dialysis is very poor. This study was undertaken to determine time-related outcomes in dialysis patients requiring cardiac valve replacement. METHODS: From 1994 to 2001, 29 end-stage renal disease (ESRD) patients on hemodialysis (HD) program underwent 30 valve replacement operations: 29 received mechanical valves (97%), and one received bioprosthetic valves. The sites of valve replacement were 11 aortic (36.7%), 18 mitral (60%), and one both aortic and mitral (3.3%). Mean age was 42.46 +/- 14.26 years (range 17-75 years). Follow-up was completed in 28 patients (96.5%). RESULTS: Early postoperative mortality (in the first 30 days) was 3.4% (n = 1). The overall estimated Kaplan-Meier survival was 56.7% at 36 months, 46.7% at 60 months, and 43.3% at 96 months. HD program was discontinued for two patients after renal transplantation in the follow-up period. All patients, except the one with bioprosthesis, used warfarin sodium for anticoagulation and none of them had bleeding. One of the patients had a major cerebrovascular accident (CVA) and another one had a minor CVA at the follow-up (6.7%). CONCLUSIONS: Life quality is better and life expectancy is longer after valve replacement in ESRD patients who have valvular disease. Also, longer life expectancy increases the probability for finding donors for kidney transplantation.     

Nasal angiomyolipoma

Angiomyolipomas (AMLs) are hamartomatous lesions containing smooth muscle, vasculature and mature adipose tissue. AML occurs most frequently in the kidneys, with the liver being the second commonest site of involvement. Other localizations for AML are extremely rare and, to our knowledge, only six cases of AML of the nasal cavity have been reported to date. Our case involved a 52-year-old male who presented with a history of snoring and obstruction of the left nasal cavity. Physical examination revealed a 3-cm polypoid mass in the left nasal cavity, which was excised surgically. Histopathologic examination revealed that the lesion was composed of smooth muscle bundles, mature adipose tissue and blood vessels of different sizes. No epitheloid smooth muscle cells were observed and HMB-45 staining was negative. In conclusion, although nasal AML is a rare lesion, it should be considered in the differential diagnosis of polypoid nasal masses, especially when the mass occurs unilaterally.     

Tuberculosis of the parotid gland

Tuberculosis of the parotid gland is very rare and clinically indistinguishable from a neoplasm. Thus the diagnosis of parotid gland involvement with tuberculosis has traditionally been made after surgical resection. We present a case which was diagnosed on fine needle aspiration cytology and managed medically.     

Intramuscular benign lipoma of the sternocleidomastoid muscle: a rare cause of neck mass

Intramuscular benign lipoma commonly is found on the extremities, but is extremely rare in the head and neck region. Intramuscular type lipomas arise between the muscle fibers and pass through the intermuscular septa, infiltrating the surrounding tissue. A 29-year-old male patient presented with the complaint of a painless and slowly growing lateral neck mass on the left side. Physical examination revealed a 4×5-cm mass adjacent to the sternocleidomastoid (SCM) muscle. CT examination revealed a lobulated, well-circumscribed 5.5×2.5-cm diameter mass with adipose tissue signal density inside the SCM muscle. The surgical exploration of the mass was done under general anesthesia, and it was excised totally. Recurrence was not seen in the 3-year follow-up. This rare entity should be considered in the differential diagnosis of intramuscularly located neck masses. Complete removal of the tumor can only succeed if planned and performed after a thorough preoperative clinical and radiological assessment in order to prevent recurrences.     

Comparison of traditional and intrafascial iliac crest bone-graft harvesting in lumbar spinal surgery

We studied 117 adult patients undergoing posterior lumbar spinal fusion and instrumentation using bone grafts from the iliac crest between February 1999 and January 2001. All patients had degenerative disease of the lumbar spine, and all were operated upon by the same surgeon. Patients were randomized to have the iliac bone graft harvested either through a separate incision (traditional approach) or utilizing the same midline incision as used for the spinal surgery (intrafascial approach). Total volume of harvested graft, blood loss, pain, complications, and patient satisfaction were evaluated with a minimum of 2-year follow-up. There were no infections. The average volume of harvested bone was 17.2 cc versus 14.7 cc; total blood loss was 168 cc versus 96 cc; total complication rate was 20% versus 8%, and overall satisfaction rate was 81% versus 96%, respectively. The intrafascial graft harvesting technique minimizes morbidity and increases patient satisfaction compared with the traditional bone harvesting technique.

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Résumé Nous avons étudié 117 malades adultes traités par arthrodèse lombaire postérieure avec instrumentation et greffe iliaque entre février 1999 et janvier 2001. Tous les malades avaient une maladie dégénérative de la colonne vertébrale lombaire et tous ont été opérés par le même chirurgien. Les malades ont été randomisés pour avoir la greffe iliaque prélevée par une incision séparée (approche traditionnelle) ou par la même incision médiane habituellement utilisée pour la chirurgie vertébrale (approche intrafasciale). Le volume totale de greffe prélevée, la perte de sang, les douleur, les complications et la satisfaction des malades ont été évalué avec un minimum de suivi de deux années. Il ny avait pas dinfection. Le volume moyen dos prélevé était 17,2 cc contre 14,7 cc; la perte totale de sang était 168 cc contre 96 cc; le taux de complications était 20% contre 8% et le taux de la satisfaction était 81% contre 96% respectivement. La technique de prélèvement intrafasciale minimise la morbidité et augmente la satisfaction du malade comparée à la technique traditionnelle de prélèvement.

     

Some arylacridine derivatives possessing potassium channel opening activity

In this study, six new 2,2,7,7-tetramethyl-9-aryl-2,3,4,5,6,7,9,10-octahydro-1,8-acridinedione derivatives (1-6) were synthesised and their functional effects on vascular potassium channels and mechanism of induced relaxations on phenylephrine-induced contractile responses in isolated rat mesenteric arteries were investigated. Pinacidil was used as standard potassium channel opener. Compounds 1, 2, 5, 6 and pinacidil induced concentration-dependent relaxation response of vessel rings previously contracted with phenylephrine.     

Quantitative MR analyses of the hippocampus: Unspecific metabolic changes in aging

Abstract The age-related structural changes of the human hippocampus are not entirely understood. The goal of the present investigation was to understand better the nature of age-related hippocampal changes by a comparative MR-analysis of four complementary aspects of hippocampal integrity: total volume, metabolite concentration, neuron to glial cell ratio and amount of extracellular diffusion space for water. To that end, we applied MR-based methods of manual and computerized (voxel-based morphometry) volumetry, diffusion-weighted imaging and ¹H MR spectroscopy to characterize specific age-related hippocampal effects in a group of 22 healthy old adults in comparison with a group of 13 healthy younger adults. Age-related reductions of the hippocampal N-acetyl aspartate to creatine/choline ratio together with only marginal age-related reductions in hippocampal volumes and increases in diffusion parameters suggest that the process of aging affects mainly the metabolic status of the hippocampus with little equivalent age-related changes in hippocampal cell density. The metabolic changes are unspecific as they are not restricted to the hippocampus but equally occur in measures obtained from extrahippocampal temporal lobe regions.     

Bone mineral density in children with nocturnal enuresis

In enuretic children there is a significantly higher incidence of fine and gross motor clumsiness, delayed developmental milestones, slower and poor linear growth, and these patients are shorter than normal children. Skeletal maturation of enuretic children has been determined with bone age in only two studies before, but to our knowledge bone mineral content of enuretic children has not previously been determined by bone mineral density measurement. Bone mineral density was measured by the dual-energy x-ray absorptiometry method in children with nocturnal enuresis and compared with that of a control group to detect whether there were any delay in bone development and any decrease in bone mass. Thirty enuretic children were compared with a control group of 40 healthy children with respect to body height and weight measurements, daily calcium intake, serum calcium, phosphorus and ALP levels, chronological and bone ages, and bone mineral density measurements. Of the parameters compared, bone age was significantly retarded, and bone mineral density was significantly reduced in children with enuresis (8.3 +/- 1.9 vs 9.7 +/- 2.3 years; p = 0.01, and 0.5476 +/- 0.07 vs 0.6077 +/- 0.05 g/cm2; p = 0.001, respectively). Chronological ages demonstrated a significant correlation with the bone ages in both the study and control groups (r = 0.852, p < 0.001, and r = 0.844, p < 0.001, respectively). However, the mean chronological age was significantly greater than the mean bone age in the study group (p < 0.001), whereas the mean chronological age was not significantly different from the mean bone age in the control group (p = 0.514). To clarify the exact mechanism responsible for these manifestations of skeletal maturation retardation, the relationship between the maturational delay of the central nervous system connections or the effect of any perinatal insult and the retardation in skeletal maturation remains to be determined.